A Novel Model Incorporating Tumor Stiffness, Blood Flow Characteristics, and Ki-67 Expression to Predict Responses After Neoadjuvant Chemotherapy in Breast Cancer

Abstract

ObjectiveTo investigate the ability of tumor stiffness, tumor blood flow, and Ki-67 expression alone or in combination in predicting the pathological response to neoadjuvant chemotherapy (NACT) in breast cancer.Patients and MethodsThis prospective cohort study included 145 breast cancer patients treated with NACT. Tumor stiffness (maximum stiffness (Emax), mean stiffness (Emean)), blood score (BS), and their relative changes, were evaluated before (t0), during (t1–t5), and at the end of NACT (t6) by shear-wave elastography and optical imaging. Ki-67 expression was quantitatively evaluated by immunohistochemistry using core biopsy specimens obtained before NACT. Pathological responses were evaluated by residual cancer burden. The ability of tumor stiffness, BS, Ki-67, and predRCB—which combined ΔEmean (t2) (the relative changes in Emean after the second NACT cycle), BS2 (BS after the second NACT cycle), and Ki-67—in predicting tumor responses was compared using receiver operating characteristic curves and the Z-test.ResultsTumor stiffness and BS decreased during NACT. ΔEmean (t2), BS2, and Ki-67 had better predictive performance than other indexes in identifying a favorable response (AUC = 0.82, 0.81, and 0.80) and resistance responses (AUC = 0.85, 0.79, and 0.84), with no significant differences between the three (p > 0.05). PredRCB had better predictive performance than any parameter alone for a favorable response (AUC = 0.90) and resistance (AUC = 0.93).ConclusionTumor stiffness, BS, and Ki-67 expression showed good and similar abilities for predicting the pathological response to NACT, and predRCB was a significantly better predictor than each index alone. These results may help design therapeutic strategies for breast cancer patients undergoing NACT.

Diagnostic Performance of Strain and Shear Wave Elastography for the Response to Neoadjuvant Chemotherapy in Breast Cancer Patients: Systematic Review and Meta‐Analysis

“…After excluding 21 duplicate publications, 42 publications were screened on the basis of title, abstract or both to determine their potential eligibility. In the end, 23 publications underwent full‐text screening, and 15 studies were finally included in the meta‐analysis 4–18 …”

“…The main characteristics of the 15 eligible studies 4–18 are summarized in Table 1. A total of 2 studies acquired data retrospectively, 7,14 whereas the remaining studies applied a prospective research design 4–6,8–13,15–18 .…”

“…The main characteristics of the 15 eligible studies 4–18 are summarized in Table 1. A total of 2 studies acquired data retrospectively, 7,14 whereas the remaining studies applied a prospective research design 4–6,8–13,15–18 . These eligible studies were published between 2012 and 2021, and a total of 1147 patients were included, with an average number of 76 patients per study.…”

“…These eligible studies were published between 2012 and 2021, and a total of 1147 patients were included, with an average number of 76 patients per study. A total of 10 studies were obtained from Asia, 5,7–10,14–17 3 from North America 4,6,12 and 2 from Europe 11,18 …”

“…In the patient selection domain, nine studies were assessed as having an unclear risk of bias due to nonrandom or nonconsecutive selection 5,6,8,10,12–16 . In the index test domain, all studies were assessed as having a high risk of bias due to no preset specificity 4–18 …”